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Successful treatment of degenerative medial meniscal tears in well-alignedss knees with fibrin clot implantation

  • Hiroshi NakayamaEmail author
  • Ryo Kanto
  • Shunichiro Kambara
  • Tomoya Iseki
  • Shintaro Onishi
  • Shinichi Yoshiya
KNEE

Abstract

Purpose

The purpose of this study was to examine the results of meniscal repair performed for symptomatic degenerative medial meniscal tears.

Methods

Twenty-four knees in 24 patients with symptomatic degenerative medial meniscal tears (mostly complex horizontal tears) who underwent isolated arthroscopic repair combined with autologous fibrin clot implantation were included in this study. The patients were followed up for a minimum of 2 years. The overall clinical outcome was evaluated using the Lysholm score, while the activity level was graded on the Tegner Activity Scale. The assessment of healing status at the repair site was based on clinical signs/symptoms and follow-up MRI examination results. In addition, the effects of the patient’s clinical and radiological factors on healing of the repaired menisci were analyzed.

Results

The mean age of the study subjects was 47.0 ± 8.1 years with a mean follow-up period of 39.3 ± 11.6 months. The Lysholm score significantly improved after surgery (P < 0.01). During the follow-up period, meniscal repairs were deemed to have failed in 6 of the 24 knees (25%). In the analysis of factors influencing meniscal healing, varus deformity (% of mechanical axis < 30%) was identified in all knees in the repair failure group, and the presence of varus deformity was shown to be a significant risk factor correlated with repair failure, while other factors did not significantly influence the healing status.

Conclusions

The short-term follow-up results showed that arthroscopic repair of degenerative medial meniscal tears combined with fibrin clot implantation attained clinical healing in 18 of 24 knees (75%) of patients, while 6 of the 24 knees (25%) of patients experienced clinical failure. The presence of varus deformity negatively affects the healing rate. In well-aligned knees, degenerative medial meniscal tears are successfully treated by isolated repair with fibrin clot implantation.

Level of evidence

IV.

Keywords

Medial meniscus Degenerative tear Fibrin clot Meniscal repair Varus Varus alignment 

Notes

Funding

No external source of funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Ahn JH, Kwon OJ, Nam TS (2015) Arthroscopic repair of horizontal meniscal cleavage tears with marrow-stimulating technique. Arthroscopy 31:92–98CrossRefGoogle Scholar
  2. 2.
    Arnoczky SP, Warren RF, Spivak JM (1988) Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Jt Surg Am 70:1209–1217CrossRefGoogle Scholar
  3. 3.
    Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 25:335–346CrossRefGoogle Scholar
  4. 4.
    Bonneux I, Vandekerckhove B (2002) Arthroscopic partial lateral meniscectomy long-term results in athletes. Acta Orthop Belg 68:356–361PubMedGoogle Scholar
  5. 5.
    Brown GC, Rosenberg TD, Deffner KT (1996) Inside-out meniscal repair using zone-specific instruments. Am J Knee Surg 9:144–150PubMedGoogle Scholar
  6. 6.
    Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10:585–608PubMedGoogle Scholar
  7. 7.
    Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Ozaki T (2017) Arthroscopic repair of the medial meniscus radial/oblique tear prevents the progression of meniscal extrusion in mildly osteoarthritic knees. Acta Med Okayama 71:413–418PubMedGoogle Scholar
  8. 8.
    Horibe S, Shino K, Nakata K, Maeda A, Nakamura N, Matsumoto N (1995) Second-look arthroscopy after meniscal repair. Review of 132 menisci repaired by an arthroscopic inside-out technique. J Bone Jt Surg Br 77:245–249CrossRefGoogle Scholar
  9. 9.
    Kamimura T, Kimura M (2014) Meniscal repair of degenerative horizontal cleavage tears using fibrin clots: clinical and arthroscopic outcomes in 10 cases. Orthop J Sports Med 10:2325967114555678Google Scholar
  10. 10.
    Kise NJ, Aga C, Engebretsen L, Roos EM, Tariq R, Risberg MA (2019) Complex tears, extrusion, and larger excision are prognostic factors for worse outcomes 1 and 2 years after arthroscopic partial; meniscectomy for degenerative meniscal tears: a secondary explorative study of the surgically treated group from the Odense-Oslo meniscectomy versus exercise (OMEX) trial. Am J Sports Med.  https://doi.org/10.1177/0363546519858602 CrossRefPubMedGoogle Scholar
  11. 11.
    Kurzweil PR, Lynch NM, Coleman S, Kearney B (2014) Repair of horizontal meniscus tears: a systematic review. Arthroscopy 30:1513–1519CrossRefGoogle Scholar
  12. 12.
    Kwak YH, Lee S, Lee MC, Han HS (2018) Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 26:781–786CrossRefGoogle Scholar
  13. 13.
    Lamplot JD, Brophy RH (2016) The role for arthroscopic partial meniscectomy in knees with degenerative changes: a systematic review. J Bone Jt Surg Br 98:934–938CrossRefGoogle Scholar
  14. 14.
    Lee DY, Park YJ, Kim HJ, Nam DC, Park JS, Song SY, Kang DG (2018) Arthroscopic meniscal surgery versus conservative management in patients aged 40 years and older: a meta-analysis. Arch Orthop Trauma Surg 138:1731–1739CrossRefGoogle Scholar
  15. 15.
    Lohmander LS, Roos H (1994) Knee ligament injury, surgery and osteoarthrosis. Truth or consequences? Acta Orthop Scand 65:605–609CrossRefGoogle Scholar
  16. 16.
    Longo UG, Ciuffreda M, Candela V, Rizzello G, D'Andrea V, Mannering N, Berton A, Salvatore G, Denaro V (2019) Knee osteoarthritis after arthroscopic partial meniscectomy: prevalence and progression of radiographic changes after 5 to 12 years compared with contralateral knee. J Knee Surg 32:407–413CrossRefGoogle Scholar
  17. 17.
    Lutz C, Dalmay F, Ehkirch FP, Cucurulo T, Laporte C, Le Henaff G, Potel JF, Pujol N, Rochcongar G, Salledechou E, Seil R, Gunepin FX, Sonnery-Cottet B; French Arthroscopy Society (2015) Meniscectomy versus meniscal repair: 10 years radiological and clinical results in vertical lesions in stable knee. Orthopp Traumatol Surg Res 101:S327–331CrossRefGoogle Scholar
  18. 18.
    Mesiha M, Zurakowski D, Soriano J, Nielson JH, Zarins B, Murray MM (2007) Pathologic characteristics of the torn human meniscus. Am J Sports Med 35:103–112CrossRefGoogle Scholar
  19. 19.
    Nakayama H, Kanto R, Kambara S, Kurosaka K, Onishi S, Yoshiya S, Yamaguchi M (2017) Clinical outcome of meniscus repair for isolated meniscus tear in athletes. AS-SMART 10:4–7Google Scholar
  20. 20.
    Paley D, Herzenberg J (2005) Principles of deformity correction, vol 3. Springer, Berlin, pp 1–18Google Scholar
  21. 21.
    Park JY, Kim BH, Ro DH, Lee MC, Han HS (2019) Characteristic location and rapid progression of medial femoral condylar chondral lesions accompanying medial meniscus posterior root tear. Knee 26:673–678CrossRefGoogle Scholar
  22. 22.
    Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27:1275–1288CrossRefGoogle Scholar
  23. 23.
    Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM (1998) The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Jt Surg Am 70:1479–1483CrossRefGoogle Scholar
  24. 24.
    Schröter S, Ihle C, Mueller J, Lobenhoffer P, Stöckle U, van Heerwaarden R (2013) Digital planning of high tibial osteotomy. Interrater reliability by using two different software. Knee Surg Sports Traumatol Arthrosc 21:189–196CrossRefGoogle Scholar
  25. 25.
    Scott GA, Jolly BL, Henning CE (1986) Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone Jt Surg Am 68:847–861CrossRefGoogle Scholar
  26. 26.
    Sekiya I, Koga H, Otabe K, Nakagawa Y, Katano H, Ozeki N, Mizuno M, Horie M, Kohno Y, Katagiri K, Watanabe N, Muneta T (2019) Additional use of synovial mesenchymal stem cell transplantation following surgical repair of a complex degenerative tear of the medial meniscus of the knee: a case report. Cell Transplant 17:963689719863793.  https://doi.org/10.1177/0963689719863793 CrossRefGoogle Scholar
  27. 27.
    Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Järvelä T, Järvinen TA, Kanto K, Karhunen J, Knifsund J, Kröger H, Kääriäinen T, Lehtinen J, Nyrhinen J, Paloneva J, Päiväniemi O, Raivio M, Sahlman J, Sarvilinna R, Tukiainen S, Välimäki VV, Äärimaa V, Toivonen P, Järvinen TL, FIDELITY (Finnish Degenerative Meniscal Lesion Study) Investigators (2017) Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomized controlled trial. Ann Rheum Dis 18:211172Google Scholar
  28. 28.
    Tsujii A, Amano H, Tanaka Y, Kita K, Uchida R, Shiozaki Y, Horibe S (2018) Second look arthroscopic evaluation of repaired radial/oblique tears of the midbody of the lateral meniscus in stable knees. J Orthop Sci 23:122–126CrossRefGoogle Scholar
  29. 29.
    Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthros 23:164–170CrossRefGoogle Scholar
  30. 30.
    Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY (2013) A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 41:1565–1570CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Hiroshi Nakayama
    • 1
    Email author
  • Ryo Kanto
    • 1
  • Shunichiro Kambara
    • 1
  • Tomoya Iseki
    • 1
  • Shintaro Onishi
    • 1
  • Shinichi Yoshiya
    • 1
  1. 1.Department of Orthopaedic SurgeryHyogo College of MedicineNishinomiya CityJapan

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